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Soler CT, Kanders SH, Olofsdotter S, Vadlin S, Åslund C, Nilsson KW. Exploration of the Moderating Effects of Physical Activity and Early Life Stress on the Relation between Brain-Derived Neurotrophic Factor (BDNF) rs6265 Variants and Depressive Symptoms among Adolescents. Genes (Basel) 2022; 13:1236. [PMID: 35886019 PMCID: PMC9319123 DOI: 10.3390/genes13071236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023] Open
Abstract
Depression affects one in five persons at 18 years of age. Allele A of the brain-derived neurotrophic factor (BDNF) rs6265 is considered to be a risk factor for depression. Previous studies of the interaction between BDNF rs6265, early adversity, and/or physical activity have shown mixed results. In this study, we explored the relation between BDNF rs6265 polymorphism and childhood stress, as well as the moderating effect of physical activity in relation to depressive symptoms using binary logistic regressions and process models 1, 2 and 3 applied to data obtained at three times (waves 1, 2 and 3) from the Survey of Adolescent Life in Västmanland cohort study (SALVe). Results revealed that both childhood stress and physical activity had a moderation effect; physical activity in wave 1 with an R2 change = 0.006, p = 0.013, and the Johnson−Neyman regions of significance (RoS) below 1.259, p = 0.05 for 11.97%; childhood stress in wave 2 with the R2 change = 0.008, p = 0 002, and RoS below 1.561 with 26.71% and >4.515 with 18.20%; and a three-way interaction in wave 1 in genotype AA carriers. These results suggest that allele A is susceptible to physical activity (positive environment) and childhood stress (negative environment).
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Affiliation(s)
- Catalina Torres Soler
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
| | - Sofia H. Kanders
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
| | - Susanne Olofsdotter
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
- Department of Psychology, Uppsala University, 75142 Uppsala, Sweden
| | - Sofia Vadlin
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
| | - Cecilia Åslund
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
- Department of Public Health and Caring Sciences, Uppsala University, 75122 Uppsala, Sweden
| | - Kent W. Nilsson
- Centre for Clinical Research, Region Västmanland, Uppsala University, 72189 Västerås, Sweden; (C.T.S.); (S.O.); (S.V.); (C.Å.); (K.W.N.)
- The School of Health, Care and Social Welfare, Mälardalen University, 72123 Västerås, Sweden
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Keijser R, Olofsdotter S, Nilsson KW, Åslund C. Three-way interaction effects of early life stress, positive parenting and FKBP5 in the development of depressive symptoms in a general population. J Neural Transm (Vienna) 2021; 128:1409-1424. [PMID: 34423378 PMCID: PMC8423649 DOI: 10.1007/s00702-021-02405-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022]
Abstract
FKBP5 gene–environment interaction (cG × E) studies have shown diverse results, some indicating significant interaction effects between the gene and environmental stressors on depression, while others lack such results. Moreover, FKBP5 has a potential role in the diathesis stress and differential susceptibility theorem. The aim of the present study was to evaluate whether a cG × E interaction effect of FKBP5 single-nucleotide polymorphisms (SNPs) or haplotype and early life stress (ELS) on depressive symptoms among young adults was moderated by a positive parenting style (PASCQpos), through the frameworks of the diathesis stress and differential susceptibility theorem. Data were obtained from the Survey of Adolescent Life in Västmanland Cohort Study, including 1006 participants and their guardians. Data were collected during 2012, when the participants were 13 and 15 years old (Wave I: DNA), 2015, when participants were 16 and 18 years old (Wave II: PASCQpos, depressive symptomology and ELS) and 2018, when participants were 19 and 21 years old (Wave III: depressive symptomology). Significant three-way interactions were found for the FKBP5 SNPs rs1360780, rs4713916, rs7748266 and rs9394309, moderated by ELS and PASCQpos, on depressive symptoms among young adults. Diathesis stress patterns of interaction were observed for the FKBP5 SNPs rs1360780, rs4713916 and rs9394309, and differential susceptibility patterns of interaction were observed for the FKBP5 SNP rs7748266. Findings emphasize the possible role of FKBP5 in the development of depressive symptoms among young adults and contribute to the understanding of possible differential susceptibility effects of FKBP5.
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Affiliation(s)
- Rebecka Keijser
- Department of Neuroscience, Uppsala University, Uppsala, Sweden. .,Centre for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, 721 89, Västerås, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Susanne Olofsdotter
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, 721 89, Västerås, Sweden
| | - Kent W Nilsson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, 721 89, Västerås, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Cecilia Åslund
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, 721 89, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Kumsta R, Kliegel D, Linden M, DeRijk R, de Kloet ER. Genetic variation of the mineralocorticoid receptor gene (MR, NR3C2) is associated with a conceptual endophenotype of "CRF-hypoactivity". Psychoneuroendocrinology 2019; 105:79-85. [PMID: 30292651 DOI: 10.1016/j.psyneuen.2018.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/22/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022]
Abstract
Recently, the "conceptual endophenotype" approach has been proposed as a means to identify subgroups of patients affected by stress-related psychiatric disorders. Conceptual endophenotypes consist of patterns of psychological, biological, and symptomatic elements. We studied a sample of patients seeking help for psychosomatic and stress-related disorders (total N = 469), who were evaluated with a diagnostic instrument that integrates psychological and biological data to derive 13 endophenotypes, or Neuropattern. The goal of this study was to explore associations between common variations of the mineralocorticoid receptor gene (MR, NR3C2), and the 13 conceptual endophenotypes of Neuropattern, as well as with the respective biological and symptom measures. A common haplotype of the MR, comprised of two functional single nucleotide polymorphism (rs2070951 G/C & rs5522 A/G), was associated with the conceptual endophenotype CRF-hypoactivity, characterized by low cortisol levels at awakening and a symptom constellation often observed in atypical depression. Homozygous carriers of the G-A haplotype (haplotype 1), previously associated with reduced dispositional optimism, increased levels of rumination and higher risk for depression, more frequently endorsed this Neuropattern. In addition to the overall association between MR variation and CRF hypoactivity, we observed in the whole sample significant associations between MR haplotypes and cortisol awakening response patterns, as well as with symptoms that characterize the CRF hypoactivity endophenotype. If replicated, MR haplotype 1 might serve as a vulnerability marker for a disorder class characterized in biological terms by reduced cortisol levels, and in terms of symptom constellation by features often observed in atypical depression.
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Affiliation(s)
- Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany.
| | - David Kliegel
- Department of Psychology, University of Trier, Trier, Germany
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Berlin, Germany; Department of Behavioral Medicine and Psychosomatics, Rehabilitation Center Seehof, Berlin, Germany
| | - Roel DeRijk
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - E Ron de Kloet
- Division of Internal Medicine, Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
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Bergemann N, Bruhn K, Loscheider K, Vogt D, Böhnke JR, Gerhards F. How to determine whether conceptual endophenotypes can improve clinical outcomes in patients suffering from major depression: An exploratory approach. Psychoneuroendocrinology 2019; 105:195-204. [PMID: 30954330 DOI: 10.1016/j.psyneuen.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/07/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
Abstract
Depression is a complex mental health disorder, resulting in a high degree of disability. Since symptom constellation, course, and outcome are heterogeneous in these patients, current research initiatives are striving to establish stratified diagnostic and treatment approaches. In the past two decades, Dirk Hellhammer and his team introduced Neuropattern, a new diagnostic concept, which is based on conceptual endophenotypes of the stress response network. We explore how to use this concept in clinical practice in order to ultimately determine whether it brings any value over standard care. In view of the novelty of the concept and the difficulties dealing with such a concept at a practical level, it was necessary to initiate an exploratory study to determine key factors for planning future clinical trials. We report results and knowledge gained from an exploratory single-site study investigating the use and potential benefits of Neuropattern in standard care. Inpatients (ICD-10 diagnosis F32, F33; Nö=ö178) were allocated to either treatment as usual (standard group, SG) or a novel Neuropattern oriented exploratory treatment (intervention group, IG). Symptom severity was assessed with psychometric tests at admission to hospital, during the first six weeks, and upon discharge from the hospital. In addition, direct and indirect costs were assessed for the 3-month-intervals prior to and after the hospital stay. Compared to the SG, depression scores of patients in the IG showed a faster decline once psychotherapeutic and pharmacological treatment were based on an individualized explanatory model. The patients in the IG with an F33 diagnosis showed a more pronounced reduction of depression severity during the stay in the hospital and a stronger and quicker reduction of general symptom severity. Comparing the average depression scores at the start of the study and after six weeks, symptom severity was reduced in all Neuropattern groups. Some limitations of the study have to be mentioned: The study was not blinded, was single-site, included highly depressed inpatients only, and was conducted for no longer than 8 months. The results highlight some important issues regarding taking the Neuropattern approach to the bedside and researching its efficacy and effectiveness to support personalized treatments in clinical care.
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Affiliation(s)
- N Bergemann
- Schoen Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany; Kitzberg Hospitals, Center for Psychosomatic Medicine and Psychotherapy, Erlenbachweg 22/24, D-97980 Bad Mergentheim, Germany.
| | - K Bruhn
- Schoen Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany; Department of Psychology, Division of Clinical and Physiological Psychology, Trier University, Johanniterufer 15, D-54290 Trier, Germany
| | - K Loscheider
- Schoen Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany; Stress Center Trier, Science Park, Max-Planck-Str. 22, D-54296 Trier, Germany
| | - D Vogt
- Department of Psychology, Division of Clinical and Physiological Psychology, Trier University, Johanniterufer 15, D-54290 Trier, Germany
| | - J R Böhnke
- Mental Health and Addiction Research Group, Hull York Medical School and Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom; Dundee Centre for Health and Related Research, School of Nursing and Health Sciences (SNHS), University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, United Kingdom
| | - F Gerhards
- Department of Psychology, Division of Clinical and Physiological Psychology, Trier University, Johanniterufer 15, D-54290 Trier, Germany
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From serendipity to clinical relevance: How clinical psychology and neuroscience converged to illuminate psychoneuroendocrinology. Psychoneuroendocrinology 2019; 105:36-43. [PMID: 30309685 DOI: 10.1016/j.psyneuen.2018.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023]
Abstract
Dirk Hellhammer and his colleagues have played a major role in creating the field of psychoneuroendocrinology from their roots in psychology. In this review, using examples from the history of the McEwen laboratory and neuroscience and neuroendocrinology colleagues, I summarize my own perspective as to how the fields of neuroscience and neuroendocrinology have contributed to psychoneuroendocrinology and how they converged with the contributions from Dirk Hellhammer and his colleagues.
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Ilg L, Kirschbaum C, Li SC, Rosenlöcher F, Miller R, Alexander N. Persistent Effects of Antenatal Synthetic Glucocorticoids on Endocrine Stress Reactivity From Childhood to Adolescence. J Clin Endocrinol Metab 2019; 104:827-834. [PMID: 30285119 DOI: 10.1210/jc.2018-01566] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/28/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT Antenatal synthetic glucocorticoid (sGC) therapy has been identified as a potent programming factor of the hypothalamic-pituitary-adrenal (HPA) axis. We previously observed significantly increased cortisol stress responses in 6- to 11-year-old, term-born children exposed to antenatal sGCs compared with controls. These findings call for longitudinal follow-up studies to evaluate long-term effects of antenatal sGCs, given that adolescence is marked by a substantial shift of HPA axis functioning. OBJECTIVE This study aimed to longitudinally investigate the stability of antenatal sGC-related effects on cortisol stress reactivity from childhood to adolescence. DESIGN, SETTING, AND PARTICIPANTS To evaluate long-term trajectories of antenatal sGCs, we longitudinally followed a subsample (n = 44) of our children's cohort into adolescence (14 to 18 years old) for a second assessment. To this end, 22 adolescents with antenatal sGC exposure and 22 untreated controls underwent a standardized laboratory stressor [Trier Social Stress Test (TSST)]. RESULTS Besides a general increase in HPA axis reactivity from childhood to adolescence (P < 0.05), participants treated with antenatal sGCs showed significantly higher cortisol levels in response to the TSST compared with controls during both developmental stages (P < 0.05). Furthermore, we observed a moderating effect of sGCs on rank-order stability of cortisol stress reactivity from childhood to adolescence (P < 0.05) with a trend (P = 0.07) for higher rank-order stability in sGC-exposed individuals (r = 0.37) compared with controls (r = -0.20). CONCLUSION These findings suggest that antenatal sGCs yield long-term changes of HPA axis reactivity that persist into adolescence and may confer increased vulnerability for developing stress-related disorders.
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Affiliation(s)
- Liesa Ilg
- Chair for Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Chair for Biopsychology, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Shu-Chen Li
- Chair for Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Franziska Rosenlöcher
- Vocational School for Obstetric Care, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Robert Miller
- Chair for Biopsychology, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Nina Alexander
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
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Contreras C, Hellhammer J, Gerhards F, Hellhammer DH. Neuropattern, a Translational Tool to Reduce Stress at Work – a Pilot Study. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41542-018-0025-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hellhammer D, Meinlschmidt G, Pruessner JC. Conceptual endophenotypes: A strategy to advance the impact of psychoneuroendocrinology in precision medicine. Psychoneuroendocrinology 2018; 89:147-160. [PMID: 29396321 DOI: 10.1016/j.psyneuen.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 01/05/2023]
Abstract
Psychobiological research has generated a tremendous amount of findings on the psychological, neuroendocrine, molecular and environmental processes that are directly relevant for mental and physical health, but have overwhelmed our capacity to meaningfully absorb, integrate, and utilize this knowledge base. Here, we reflect about suitable strategies to improve the translational success of psychoneuroendocrinological research in the era of precision medicine. Following a strategy advocated by the National Research Council and the tradition of endophenotype-based research, we advance here a new approach, termed "conceptual endophenotypes". We define the contextual and formal criteria of conceptual endophenotypes, outline criteria for filtering and selecting information, and describe how conceptual endophenotypes can be validated and implemented at the bedside. As proof-of-concept, we describe some of our findings from research that has adopted this approach in the context of stress-related disorders. We argue that conceptual endophenotypes engineer a bridge between the bench and the bedside. This approach readily lends itself to being continuously developed and implemented. Recent methodological advances, including digital phenotyping, machine learning, grassroots collaboration, and a learning healthcare system, may accelerate the development and implementation of this conceptual endophenotype approach.
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Affiliation(s)
- Dirk Hellhammer
- Department of Psychology, University of Trier, D-54286 Trier, Germany.
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, Faculty of Medicine, University of Basel and University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse 60/62, CH-4055 Basel, Switzerland; Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse 1, D-10555 Berlin, Germany.
| | - Jens C Pruessner
- Department of Psychology, University of Konstanz, D-78457 Konstanz, Germany.
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Peter HL, Hellhammer DH. Entzündungsbedingte Depression und assoziierte Risikofaktoren bei ambulanten Patienten. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000452785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Waeldin S, Vogt D, Linden M, Hellhammer DH. Frequency of Perceived Poststress Symptoms in Inpatients, Outpatients and Healthy Controls: The Role of Perceived Exhaustion and Stress. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 85:36-44. [PMID: 26609888 DOI: 10.1159/000438866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Poststress symptoms occur as a consequence of stress, most commonly during leisure periods such as weekends and vacations. However, the prevalence and the pathological mechanisms of poststress symptoms are poorly understood. METHODS Here, we compared the frequency of poststress symptoms in healthy controls (n = 984), outpatients (n = 420), and inpatients (n = 101). In outpatients, demographic factors, psychosocial stress, and perceived exhaustion were tested as predictors of poststress symptoms with multivariate regression analysis. Poststress symptoms and perceived exhaustion were assessed using 2 Neuropattern Questionnaires (the NPQ - Patient Questionnaire and the NPQ - Symptom List), and psychosocial stress was evaluated using the Patient Health Questionnaire (PHQ). RESULTS Poststress symptoms appeared in 2.9% of healthy controls, 20.0% of outpatients, and 34.7% of inpatients. Predictors were educational level, psychosocial stress, and perceived exhaustion. Poststress symptoms differed primarily between exhausted (75.0%) and nonexhausted patients (25.0%). CONCLUSION Poststress symptoms are rather common in clinical populations, and they are primarily associated with the degree of perceived exhaustion. Preliminary evidence suggests that poststress symptoms are possibly related to depletion of norepinephrine stores, which may facilitate a stratified preventive and therapeutic treatment of these subjects.
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Affiliation(s)
- Sandra Waeldin
- Department of Clinical and Physiological Psychology, University of Trier, Trier, Germany
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Effects of genetic and early environmental risk factors for depression on serotonin transporter expression and methylation profiles. Transl Psychiatry 2014; 4:e402. [PMID: 24937096 PMCID: PMC4080318 DOI: 10.1038/tp.2014.37] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/13/2014] [Accepted: 04/16/2014] [Indexed: 12/16/2022] Open
Abstract
The serotonin transporter (SERT) gene-linked polymorphic region (5-HTTLPR) has been implicated in moderating the link between life stress and depression. However, respective molecular pathways of gene-environment (GxE) interaction are largely unknown. Sustained alterations in SERT gene expression profiles, possibly mediated by epigenetic modifications, are a frequent correlate of depression and may thus constitute a putative mediator of GxE interaction. Here, we aimed to investigate joint effects of 5-HTTLPR and self-reported environmental adversity throughout the lifespan (prenatal, early and recent stress/trauma) on in vivo SERT mRNA expression in peripheral blood cells. To further evaluate whether environmentally induced changes in SERT expression are mediated by epigenetic modifications, we analyzed 83 CpG sites within a 799-bp promoter-associated CpG island of the SERT gene using the highly sensitive method of bisulfite pyrosequencing. Participants were 133 healthy young adults. Our findings show that both the 5-HTTLPR S allele and maternal prenatal stress/child maltreatment are associated with reduced in vivo SERT mRNA expression in an additive manner. Remarkably, individuals carrying both the genetic and the environmental risk factors exhibited 32.8% (prenatal stress) and 56.3% (child maltreatment) lower SERT mRNA levels compared with those without any risk factor. Our data further indicated that changes in SERT mRNA levels were unlikely to be mediated by DNA methylation profiles within the SERT CpG island. It is thus conceivable that the persistent changes in SERT expression may in turn relate to altered serotonergic functioning and possibly convey differential disease vulnerability associated with 5-HTTLPR and early adversity.
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